Angelina Jolie Pitt's Surgery: Why She Had Her Ovaries Removed

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Angelina Jolie Pitt underwent preventative surgery to remove her
ovaries and fallopian tubes, according to the Op-Ed in the New
York Times today that the actress, director and United Nations
envoy wrote.

Two years ago, Jolie Pitt elected to have a preventative double
mastectomy after learning that she had a mutation in the BRCA1
gene, a gene that codes for tumor-suppressing proteins, which
normally repair damaged DNA.

"When someone has a harmful mutation in that gene, it no longer
allows the cell to repair itself, and then the cells can go awry
and become cancerous," said Dr. Marleen Meyers, the director of
the Survivorship Program at the New York University Perlmutter
Cancer Center, who was not involved with Jolie Pitt's medical
care. [ 5
Things Women Should Know About Ovarian Cancer ]

Breast and ovarian cancer are more prevalent among women with the
harmful BRCA1 mutation. About 12 percent of women in the general
population develop breast cancer, but up to 65 percent of women
with a BRCA1 mutation develop the disease by age 70, according to
the National Cancer Institute.

Likewise, about 1.4 percent of women in the general population
develop ovarian cancer, but about 39 percent of women with a
BRCA1 mutation develop it by the time they're 70 years old, the
NCI reports.

What's more, Jolie Pitt's mother died of
breast cancer at age 56, and the actress' aunt and
grandmother also died of cancer, giving her a strong family
history of the disorder, according to Jolie Pitt.

But she was aware of the risk, she writes. After her mastectomy,
Jolie Pitt continued to get checked for ovarian cancer. One
test she had monitored her levels of CA-125, a protein that tends
to increase in women with ovarian cancer. But that test isn't
very sensitive, and shouldn't be used by itself to detect early
ovarian cancer, Meyers told Live Science.

"It's not a very good screening tool," Meyers said. "I appreciate
that she was having it, but it's more a tool that's used once
someone has ovarian cancer and they're getting treatment. Then it
can be used to follow the progress of the treatment."

However, Jolie Pitt's doctors were also screening her levels of
other inflammatory cells and proteins. These markers were
elevated and possibly a sign of early cancer, her doctors told
her.

It's likely that these markers were similar to CA-125,
but are better at picking up earlier stages of ovarian cancer,
Meyers said. Research into these markers is still in its early
stages, but the results look promising so far, she said.

After a series of body imaging tests, including a CT and a PET,
and a tumor test, Jolie Pitt learned that she did not have
cancer. But she realized that it could still develop at any time,
and her doctors helped her decide that removing her ovaries and
fallopian tubes was a good option for her.

However, Jolie Pitt still has an increased risk of cancer. A
harmful BRCA1 mutation can increase the risk of other cancers,
such as colon cancer and melanoma. And the body also has
ovarian-type cells in the abdomen, which can also become
cancerous, Meyers said.

Jolie Pitt is "incredibly courageous," for sharing her
experience, Meyers said. "I think it was being proactive and I
think it's putting a beautiful face on genetic testing." It also
brings attention to menopause, which Jolie Pitt will go through
now that her ovaries are gone.

There was a surge in the number of women who requested
preventative double mastectomies after
Jolie Pitt made her first announcement in 2013, Meyers said.
Women with the BRCA1 gene who are considering removing their
fallopian tubes and ovaries can take Jolie Pitt's experience into
account, but Meyers advised that women do what is best for their
bodies, as surgery can carry risks of complications and
infections.

"In women who carry the gene, it's a reasonable thing to consider
and talk about, but it's still a decision that needs to be made
one-on-one" with a doctor, Meyers said.